Coronary Microvascular Dysfunction (CMD)

Over the past two decades, coronary microvascular dysfunction (CMD) has emerged as an important mechanism of myocardial ischemia. This chapter describes various pathogenic mechanisms of CMD and explains how CMD can result from functional and/or structural alterations to the vessel wall and lead to varying degrees of disruption to normal coronary physiology. Currently ≈20–50% of patients have a predisposition towards ongoing angina despite successful revascularization surgery. The current goal of percutaneous coronary intervention (PCI) or any other revascularization therapy is to relieve the symptoms rather than address the pathology. It will require new research in this area if an improvement in CMD pathology is to be achieved.